Sleep and Breathing

, Volume 17, Issue 1, pp 259–266 | Cite as

Validation of ApneaLink Ox™ for the diagnosis of obstructive sleep apnea

  • Carlos Alberto Nigro
  • Eduardo Dibur
  • Silvana Malnis
  • Sofia Grandval
  • Facundo Nogueira
Original Article

Abstract

Objective

The aim of the study was to validate the automatic and manual analysis of ApneaLink Ox™ (ALOX) in patients with suspected obstructive sleep apnea (OSA).

Methods

All patients with suspected OSA had a polysomnography (PSG) and an ALOX performed in the sleep laboratory. For automatic analysis, hypopnea was defined as a decrease in airflow ≥30 % of baseline for at least 10 s plus oxygen desaturation ≥3 or 4 %. While for the manual analysis, hypopnoea was considered when a reduction of airflow ≥30 % of ≥10 s plus oxygen desaturation ≥3 % or increase in cardiac rate ≥5 beats/min were identified or, when only a reduction of airflow ≥50 % was observed. OSA was defined as a respiratory disturbance index (RDI) ≥5. The apnea/hypopnea automatic index (AHI3-a, AHI4-a) and manual index were estimated. Receiver operating characteristics (ROC) analysis and the agreement between ALOX and PSG were performed.

Results

Fifty-five patients were included (38 men; mean age, 48.2; median, RDI 15.1; median BMI, 30 Kg/m2). The automatic analysis of ALOX under-estimated the RDI from PSG, mainly for the criterion of oxygen desaturation ≥4 % (AHI3-a–RDI, −3.6 ± 10.1; AHI4-a–RDI, −6.5 ± 10.9, p < 0.05). The autoscoring from ALOX device showed a better performance when it was set up to identify hypopneas with an oxygen desaturation criterion of ≥3 % than when it was configured with an oxygen desaturation criterion of ≥4 % (area under the receiver operator curves, 0.87 vs. 0.84). Also, the manual analysis was found to be better than the autoscoring set up with an oxygen desaturation of ≥3 % (0.923 vs. 0.87). The manual analysis showed a good interobserver agreement for the classification of patients with or without OSA (k = 0.81).

Conclusion

The AHI obtained automatically from the ApneaLink Ox™ using oxygen desaturation ≥3 % as a criterion of hypopnea had a good performance to diagnose OSA. The manual scoring from ApneaLink Ox™ was better than the automatic scoring to discriminate patients with OSA.

Keywords

Portable sleep monitoring Obstructive sleep apnea Sleep apnea syndromes Diagnosis 

Notes

Acknowledgments

The authors wish to thank Ms. Jaquelina Mastantuono for revising the English text.

Disclosure of financial support

None.

Disclosure of any conflicts of interest

Carlos A. Nigro received two ApneaLink Ox devices by the company AirLiquide Argentina to perform this study.

References

  1. 1.
    Young T, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165:1217–1239PubMedCrossRefGoogle Scholar
  2. 2.
    Huang SG, Li QY (2003) Prevalence of obstructive sleep apnea/hypopnea syndrome in Chinese adults aged over 30 yr in Shanghai. Zhonghua Jie He He Hu Xi Za Zhi 26:268–272PubMedGoogle Scholar
  3. 3.
    Ip MS, Lam B, Lauder IJ, Tsang KW, Chung KF, Mok YW, Lam WK (2001) A community study of sleep disordered breathing in middle-aged Chinese men in Hong Kong. Chest 119:62–69PubMedCrossRefGoogle Scholar
  4. 4.
    Sharma SK, Kumpawat S, Banga A, Goel A (2006) Prevalence and risk factors of obstructive sleep apnea syndrome in a population of Delhi, India. Chest 130:149–156PubMedCrossRefGoogle Scholar
  5. 5.
    Caterson ID, Hubbard V, Bray GA, Grunstein R, Hansen BC, Hong Y, Labarthe D, Seidell JC, Smith SC Jr (2004) Prevention Conference VII: obesity, a worldwide epidemic related to heart disease and stroke: Group III: worldwide comorbidities of obesity. Circulation 110:e476–e483PubMedCrossRefGoogle Scholar
  6. 6.
    Peppard PE, Young T, Palta M, Skatrud J (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342:1378–1384PubMedCrossRefGoogle Scholar
  7. 7.
    Newman AB, Nieto J, Guirdry U, Lind BK, Redline S, Pickering TG, Quan SF, Sleep Heart Health Study Research Group (2001) Relation of sleep-disordered breathing to cardiovascular risk factors. Am J Epidemiol 154:50–59PubMedCrossRefGoogle Scholar
  8. 8.
    Lavie P, Herer P, Peled R, Berger I, Yoffe N, Zomer J, Rubin AH (1995) Mortality in sleep apnoea patients; multivariate analysis of risk factors. Sleep 18:149–157PubMedGoogle Scholar
  9. 9.
    No authors listed (1997) Practice parameters for the indications for polysomnography and related procedures. Polysomnography Task Force, American Sleep Disorders Association Standards of Practice Committee. Sleep 20:406–422Google Scholar
  10. 10.
    Flemons WW, Douglas NJ, Kuna ST, Rodenstein DO, Wheatley J (2004) Access to diagnosis and treatment of patients with suspected sleep apnea. Am J Respir Crit Care Med 169:668–672PubMedCrossRefGoogle Scholar
  11. 11.
    Ferber R, Millman R, Coppola M, Fleetham J, Murray CF, Iber C, McCall V, Nino-Murcia G, Pressman M, Sanders M (1994) Portable recording in the assessment of obstructive sleep apnea. ASDA standards of practice. Sleep 17:378–392PubMedGoogle Scholar
  12. 12.
    Erman MK, Stewart D, Einhorn D, Gordon N, Casal E (2007) Validation of the ApneaLink for the screening of sleep apnea: a novel and simple single-channel recording device. J Clin Sleep Med 3:387–392PubMedGoogle Scholar
  13. 13.
    Chen H, Lowe AA, Bai Y, Hamilton P, Fleetham JA, Almeida FR (2009) Evaluation of a portable recording device (ApneaLink) for case selection of obstructive sleep apnea. Sleep Breath 13:213–219PubMedCrossRefGoogle Scholar
  14. 14.
    Ragette R, Wang Y, Weinreich G, Teschler H (2010) Diagnostic performance of single airflow channel recording (ApneaLink) in home diagnosis of sleep apnea. Sleep Breath 14:109–114PubMedCrossRefGoogle Scholar
  15. 15.
    Nigro CA, Dibur E, Aimaretti S, González S, Rhodius E (2011) Comparison of the automatic analysis versus the manual scoring from ApneaLink™ device for the diagnosis of obstructive sleep apnoea syndrome. Sleep Breath 15:679–686PubMedCrossRefGoogle Scholar
  16. 16.
    Oktay B, Rice TB, Atwood CW Jr, Passero M Jr, Gupta N, Givelber R, Drumheller OJ, Houck P, Gordon N, Strollo PJ Jr (2011) Evaluation of a single-channel portable monitor for the diagnosis of obstructive sleep apnea. J Clin Sleep Med 7:384–390PubMedGoogle Scholar
  17. 17.
    BaHammam AS, Sharif M, Gacuan DE, George S (2011) Evaluation of the accuracy of manual and automatic scoring of a single airflow channel in patients with a high probability of obstructive sleep apnea. Med Sci Monit 17:MT13–MT19PubMedCrossRefGoogle Scholar
  18. 18.
    Weinreich G, Armitstead J, Töpfer V, Wang YM, Wang Y, Teschler H (2009) Validation of ApneaLink as screening device for Cheyne–Stokes respiration. Sleep 32:553–557PubMedGoogle Scholar
  19. 19.
    Gantner D, Ge JY, Li LH, Antic N, Windler S, Wong K, Heeley E, Huang SG, Cui P, Anderson C, Wang JG, McEvoy D (2010) Diagnostic accuracy of a questionnaire and simple home monitoring device in detecting obstructive sleep apnoea in a Chinese population at high cardiovascular risk. Respirology 15:952–960PubMedCrossRefGoogle Scholar
  20. 20.
    Chai-Coetzer CL, Antic NA, Rowland LS, Catcheside PG, Esterman A, Reed RL, Williams H, Dunn S, McEvoy RD (2011) A simplified model of screening questionnaire and home monitoring for obstructive sleep apnoea in primary care. Thorax 66:213–219PubMedCrossRefGoogle Scholar
  21. 21.
    Areias V, Romero J, Cunha K, Faria R, Mimoso J, Gomes V, Brito U (2012) Sleep apnea-hypopnea syndrome and acute coronary syndrome—an association not to forget. Rev Port Pneumol 18:22–28PubMedCrossRefGoogle Scholar
  22. 22.
    Rechtschafen A, Kales A (1968) A manual of standarized technology, techniques and scoring system for sleep stages of human subjects. Brain Information Service, Brain Information Institute, University of California, Los AngelesGoogle Scholar
  23. 23.
    Atlas Task Force of the ASD (1992) EEG arousals: scoring rules and examples. Sleep 15:174–184Google Scholar
  24. 24.
    Consenso Nacional sobre el Síndrome Apneas-Hipopneas del Sueño del Grupo Español de Sueño (2005) Definición y concepto, fisiopatología, clínica y exploración del SAHS. Arch bronconeumol 41 Extraordinario 4:12–29Google Scholar
  25. 25.
    Ayappa I, Norman RG, Krieger AC, Rosen A, O'malley RL, Rapoport DM (2000) Non-invasive detection of respiratory effort-related arousals (REras) by a nasal cannula/pressure transducer system. Sleep 23:763–771PubMedGoogle Scholar
  26. 26.
    Sala H, Nigro C, Rabec C, Guardia AS, Smurra M (2001) Consenso Argentino de Trastornos Respiratorios Vinculados al Sueño. Medicina 61:351–363PubMedGoogle Scholar
  27. 27.
    Guilleminault C, Bassiri A (2005) Clinical features and evaluation of obstructive sleep apnea-hypopnea syndrome and upper airway resistance syndrome. In: Kryger MH, Roth T, Dement WC (eds) Principles and practice of sleep medicine, 4th edn. Elsevier, Philadelphia, pp 1043–1052CrossRefGoogle Scholar
  28. 28.
    Farré R, Rigau J, Montserrat JM, Ballester E, Navajas D (2001) Relevance of linearizing nasal prongs for assessing hypopneas and flow limitation during sleep. Am J Respir Crit Care Med 163:494–497PubMedGoogle Scholar
  29. 29.
    Winkelman JW (1999) The evoked heart rate response to periodic leg movements of sleep. Sleep 22:575–580PubMedGoogle Scholar
  30. 30.
    Somers VK, Javaheri S (2005) Cardiovascular effects of sleep related breathing disorders. In: Kryger MH, Roth T, Dement WC (eds) Principles and practice of sleep medicine, 4th edn. Elsevier, Philadelphia, pp 1180–1191CrossRefGoogle Scholar
  31. 31.
    Pita Fernández S, Pértega Díaz S (2003) Pruebas diagnósticas. Cad Aten Primaria 10:120–124Google Scholar
  32. 32.
    Koziej M, Cieslicki JK, Gorzelak K, Sliwinski P, Zielinski J (1994) Hand-scoring of MESAM 4 recordings is more accurate than automatic analysis in screening for obstructive sleep apnoea. Eur Respir J 7:1771–1775. doi: 10.1183/09031936.94.07101771 PubMedCrossRefGoogle Scholar
  33. 33.
    Esnaola S, Duran J, Infante-Rivard C, Rubio R, Fernandez A (1996) Diagnostic accuracy of a portable recording device (MESAM IV) in suspected obstructive sleep apnoea. Eur Respir J 9:2597–2605PubMedCrossRefGoogle Scholar
  34. 34.
    Calleja JM, Esnaola S, Rubio R, Duran J (2002) Comparison of a cardiorespiratory device versus polysomnography for diagnosis of sleep apnoea. Eur Respir J 20:1505–1510PubMedCrossRefGoogle Scholar
  35. 35.
    Dingli K, Coleman EL, Vennelle M, Finch SP, Wraith PK, Mackay TW, Douglas NJ (2003) Evaluation of a portable device for diagnosing the sleep apnoea/hypopnoea syndrome. Eur Respir J 21:253–259PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Carlos Alberto Nigro
    • 1
    • 3
  • Eduardo Dibur
    • 1
    • 4
  • Silvana Malnis
    • 1
    • 4
  • Sofia Grandval
    • 2
    • 5
  • Facundo Nogueira
    • 2
    • 5
  1. 1.Sleep Laboratory, Pneumonology UnitHospital AlemánBuenos AiresArgentina
  2. 2.Instituto Argentino de Investigación NeurológicaBuenos AiresArgentina
  3. 3.Buenos AiresArgentina
  4. 4.Buenos AiresArgentina
  5. 5.Buenos AiresArgentina

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